Effect of chemotherapy: Hearing Loss

[Mary]

Hearing Loss Is Common in Children Treated With Platinum-Based Chemotherapy Drugs
This article was found here.

More than half of children treated with the chemotherapy drugs cisplatin or carboplatin experience some degree of hearing loss as a result of treatment, according to a study published in the Journal of Clinical Oncology .

The development of new chemotherapy drugs and new chemotherapy regimens has resulted in improved survival for pediatric as well as adult cancer patients. The benefits of these treatments, however, are sometimes accompanied by long-term adverse effects.

In the case of platinum-based chemotherapy drugs such as cisplatin and carboplatin, adverse effects may include permanent hearing loss. This hearing loss typically involves a reduced ability to hear high-frequency sounds in both ears. The extent of hearing loss is associated with the duration and dose of chemotherapy. Hearing loss in children is of particular concern since it has the potential to affect speech and language development, social interactions, and educational achievement.

In order to assess the frequency and severity of hearing loss in pediatric cancer patients treated with cisplatin or carboplatin, researchers in Oregon evaluated 67 children between the ages of 8 months and 23 years. The most common tumors in these children were medulloblastoma, osteosarcoma, and neuroblastoma. Forty patients were treated with cisplatin alone, 19 were treated with both cisplatin and carboplatin, and eight were treated only with carboplatin.

Hearing was assessed at baseline (before chemotherapy) and was then monitored at regular intervals during chemotherapy.

    * Decreases in hearing in both ears occurred in 61% of patients.
    * Median time to hearing loss was 135 days.
    * Frequency of hearing loss was greatest among patients treated for medulloblastoma or osteosarcoma (88% and 75%, respectively).
    * The most severe hearing loss developed among children treated for neuroblastoma.
    * Hearing aids were recommended for 41% of patients with hearing loss.
    * Among 14 patients with hearing loss and long-term follow-up information, there was no improvement in hearing during an average of 20 months of follow-up. Hearing worsened during follow-up in three of these subjects.

The researchers conclude that hearing loss is frequent in pediatric cancer patients treated with platinum-based chemotherapy drugs. Studies are being developed to test agents that could reduce the likelihood of hearing loss among patients treated with platinum-based chemotherapy drugs.

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Reference: Gilmer Knight KR, Kraemer DF, Neuwelt EA. Ototoxicity in Children Receiving Platinum Chemotherapy: Underestimating a Commonly Occurring Toxicity That May Influence Academic and Social Development. Journal of Clinical Oncology. 2005;23:8588-8596.
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These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. All readers should verify all information and data before administering any drug, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein.

[Mike]

Very interesting Mary. My wife thinks I suffer from "selective" hearing. I've always thought my hearing loss was because of playing in too many rock bands. But this article seems to make the most sense. I had 3 years of Cisplatin, and have noticed that I have trouble hearing high frequencies.

I think I'll mention it to my doc.

Thanks for sharing....again, great info!

[Chris]

I have also noticed a difference mostly in my tinnitus.  It's much louder, a different pitch and will periodically get louder and change pitch, too.  The first time I took Cisplatin it was temporary and went away after a couple of weeks, this last time has lasted about 3 months, so I'm pretty much resigned to the fact that this one is permanent.  I'm thrilled...........



Chris

[Mariana]

Tinnitus and hearing loss are some of my daily reminders of sarcoma...Some of my friends joke because I hear all kinds of things that are total opposite of what was said!  But it does get super annoying...especially at night or whenever there is total silence...the noise in my head can get unbearable.   

[Cari]

Yes I agree the noises and the different pithes they come in are very annoying--I sleep with the TV on now because when it is completely quiet in the room I want to shake my head and tell it to shutup!!-if we put all of our ear ringings together we could probably make some good music!!

[Mike]

I always thought that people were just jealous because they couldn't hear the voices in my head!!! Now, I guess it's just chemo ears, not voices. Too bad, they were kinda nice sometimes.

[Jo Ann]

^{Mike please ... I have voices they keep me company and I have not had chemo ... ok.. So I am not jealous...}

While reading these posts I decided to see if there were any websites that were offering any type of treatment or at least some suggestions.. This is what I found...


Managing Side Effects Treatment & Prevention

http://patient.cancerconsultants.com/supportive_treatment.aspx?id=23157#a5
 
Hearing Problems
Overview
Some drugs may cause damage to your inner ear, particularly platinum-based chemotherapy drugs.  Other drugs that you may be taking in conjunction with your treatment may also contribute to hearing loss. Damage to your inner ear may cause hearing loss, dizziness and ringing in the ears. While there are no drug treatments for this side effect, there are steps you can take to manage your symptoms.

What hearing problems can be caused by cancer treatment?
Which chemotherapy drugs cause hearing problems?
How do chemotherapy drugs cause hearing problems?
What are some symptoms of damage to your ears?
How are hearing problems treated?
What else can I do?
What hearing problems can be caused by cancer treatment?
Some cancer treatments may cause damage to the inner ear, also called ototoxicity, resulting in temporary or permanent hearing loss, dizziness and/or ringing in the ears (tinnitus). If you already have hearing loss, this damage may cause it to worsen.

Which chemotherapy drugs cause hearing problems?
The following chemotherapy drugs have been reported to cause hearing problems in 10-29% of patients:

Cisplatin (Platinol®)
Carboplatin (Paraplatin®)
Mechlorethamine (Mustargen®)
There are many other drugs that may cause hearing problems in some people. Some of the common ones that cancer patients may be taking include:

Aspirin (high-dose, long-term use)
Aminoglycoside antibiotics: erythromycin, gentamycin, tobramycin or streptomycin
Anti-nausea medications: promethazine (Phenergan®).
Diuretics: furosemide (Lasix®), acetazolamide (Diamox®)
Heart and blood pressure medications: metoprolol (Lopressor®)
Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Advil®) naproxen sodium (Aleve®)
How do chemotherapy drugs cause hearing problems?
The platinum-based chemotherapy drugs are thought to cause ototoxicity by producing free radicals.[1] Free radicals are unstable molecules which are produced during many normal cellular processes that involve oxygen, such as burning fuel for energy. They are also formed from exposure to elements in the environment, like radiation, tobacco smoke and chemotherapy drugs. Free radicals are very reactive, meaning they interact with other atoms in order to regain a more balanced state. In this way, free radicals cause damage to cell walls, certain cell structures, and genetic material within the cells.

What are some symptoms of damage to your ears?
Ototoxicity may cause sounds to seem muffled. You may also experience ringing or abnormal sounds in the ears, a condition called tinnitus. Tinnitus can interfere with your ability to rest, concentrate or sleep at night. As your ototoxicity becomes worse, the sounds become louder.

Because your inner ear is involved in your sense of balance, one of the signs of ototoxicity is dizziness. If your dizziness worsens, it may be accompanied with nausea and vomiting. Notify your doctor immediately if you have any of these symptoms.

How are hearing problems treated?
If you have hearing loss, your doctor may recommend that you be fitted for a hearing aid. While there are not drug treatments for ototoxicity, research is ongoing to find new techniques to manage this side effect. For example, preliminary research suggests that ototoxicity caused by cisplatin may be ameliorated by melatonin and other antioxidants.[2] Antioxidants are organic substances that protect cells from the damaging effects of free radicals.

What else can I do?
There are a number of things you can do to help manage your hearing problems.

Avoid loud noises to prevent further damage.
Drink plenty of water to avoid dehydration, which may worsen your symptoms.
Avoid stress, anxiety and fatigue, which may worsen your symptoms.
Use a quiet radio, television or any low level sounds when you are trying to rest. The background sound may help you ignore the tinnitus and make it easier to sleep or rest.
Notify your doctor if you have any changes in the patterns of hearing problems that you are experiencing.

References


--------------------------------------------------------------------------------

[1] Evans P, Halliwell B. Free radicals and hearing. Cause, consequence, and criteria. Ann N Y Acad Sci. 1999 Nov 28; 884: 19-40.

[2] Lopez-Gonzalez MA, Guerrero JM, Rojas F, Delgado F. Ototoxicity caused by cisplatin is ameliorated by melatonin and other antioxidants. Journal of Pineal Research 2000; 28(2):73.


CancerConsultants.com ©1998-2005, last updated 05/04, Authored by Charles H. Weaver, M.D., Managing Editor and C. D. Buckner, M.D., Scientific Editor. CancerConsultants.com, All Rights Reserved.

The information contained above is general in nature and is not intended as a guide to self-medication by consumers or meant to substitute for advice provided by your own physician or other medical professional. The reader is advised to consult with a physician or other medical professional and to check product information (including packaging inserts) for changes and new information regarding dosage, precautions, and contra indication before administering any drug, herb, supplement, compound, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein. 


and I found this too.... By the way it was a leading complaint with the over sixty crowd at the family doctor I worked for... but pretty easily taken care of with a medication...


What Causes Bilateral Vestibulopathy?

About 5% of all dizziness is due to bilateral vestibulopathy. In about 50% of cases, bilateral vestibulopathy is due to exposure to an ototoxic medication. Gentamicin is an antibiotic medication and gentamicin toxicity is the most common single known cause of bilateral vestibulopathy, accounting for 15 to 50% of all cases. Ototoxicity can also be due to infection (meningitis, about 10%); Ménière's disease; sarcoidosis; bilateral ear surgery, such as for certain forms of acoustic neuroma or bilateral vestibular neuritis; congenital disorders with deafness, such as the Mundini malformation; and, very rarely, from disorders of the immune system. One rare familial form, migraine associated vertigo (MAV),is associated with migraine. Advanced age is another risk factor, since normally vestibular ganglion cell counts decrease with age so that by the age of 80 years, about 50% of vestibular neurons remain. In about one- third of all cases, no cause can be identified for bilateral vestibulopathy (Syms and House, 1997).

There is also accumulating evidence that free radical generation plays an important role in ototoxicity. This information is the basis of experimental treatments to prevent ototoxicity.



How is Bilateral Vestibulopathy Treated?

Treatment involves finding out the cause and treating it, if possible. If the damage has already been done, then the focus of treatment is upon avoidance of vestibular suppressants and ototoxins. Vestibular rehabilitation is important to speed recovery and prevent setbacks. We recommend that you tell health care workers that you cannot take drugs that end in mycin (like Azithromycin and Erythromycin), because of possible reaction. This will keep you from contact with the most common ototoxins. Asprin and nonsteroidal anti-inflammatory drugs can also affect hearing. It may be prudent to avoid these drugs, or at least large doses of them. Antihistamines,[like Antivert (meclizine) or Dramamine, and benzodiazepines (Valium-like drugs like Klonopin, Xanax, and Ativan) are temporary vestibular suppressants. While they won't permanently harm you, typically they make imbalance temporarily worse. A list of the most common problem medication follows.

Read More at the link below...

http://www.american-hearing.org/name/bilateral_vestibulopathy.html

[Randy W]

Per the attached article, people are starting to consider the hearing loss problem caused by high dose chemo used to treat childhood cancers (ie osteosarcoma, etc.).  Personally, I still have ringing in my ears from cisplatin and some trouble hearing high voice tones.

http://news.yahoo.com/s/nm/20051219/hl_nm/chemo_hearing_kids_dc

[Kelly]

Hi guys,

Tylar took the Cisplatin.  She has a substantial loss in the high tones.  We do get hearing tests every 4 months since there is a loss.  When we go back for hearing tests next time if there is anymore loss, she will be a candidate for hearing aides.   So we will see.

Kelly - Mom to Survivor Tylar - Age 8
Osteosarcoma of the right mandible, dx 06/2004, surgery x5, off treatment 04/2005 and NED!!

[Charlene]

JoAnn I found tha article very informative but i had to laugh at the list of things to avoid "stress, anxiety and fatigue, which may worsen your symptoms."  it just gave me a giggle.  how the heck does one do that when dealing with the darn chorus erupting in ones head.  goes something like buzz, ring, hum, buzz, then the airplane takes off.  woohoo!  what a ride going on in there.

so obviously, i suffer from tinnitis and hearing loss.  enough so that if i wanted i could qualify for hearing aides.  the trouble with hearing aides is they can still make it difficult to hear clearly with background noise.  which is one of my major problems.  there are also special devices they use to help drown out the background noice but it can be ineffective with tinnitus.  something that has helped me to hear better is folding my ears forward.  sounds crazy and looks silly but it works.  i listen to a fan at night to sleep.  helps drown out the chorus in my head.  i also got relief from craniosacral therapy but it's expensive.  i'm thinking of trying accupuncture for it but it's another added expense.

it drives me mad at times.  literally feel like pulling my hair out.  especially when each ear has its own tune it carrries. 

warning:  (that my audiologist gave me) if you suddenly find you have lost complete hearning in one or both ears get immediately get to a hearing doctor as there can sometimes be something to do to save the hearing.  hope i didn't scare anyone there.  sorry. 

also, it's important to note that audiology follow-up is part of the long term follow quidelines.

cari - i like your idea for a music CD.  imagine the money we could raise for sarcoma research if we could pull the noise from our heads.  LOL!

WHAT i can't hear you!!!!

charlene

p.s. there is hope that the intensity will decrease over time.  it did for me but has never gone away.  i'm definately going to pay more attention to it's pattern.  as i live on advil.  and lately have been dehydrated.

[Mary]

Another article stating that hearing loss after chemotherapy is underestimated.

[David]

Interesting reading....I had cisplatin during my treatment. Is that the one that left a metallic aftertaste? Not sure.... 

I notice that whenever I'm in a noisy environment, typically bar / pub / nightclub I am unable to hear people who are around the table. They obviously have no problems, I have to ask people to repeat / speak up, or miss discussions, not exactly conducive to easy conversation.

All these nasty after-effects. I was told "after 5 years you're ok". I guess that meant the likelihood of getting cancer is pretty much nil, or at least as probable as the normal population.

There again, we are lucky to have survived, we should not complain, it happened so long ago (in my case), stop complaining. ;-)

Not complaining for once, just thought I'd also share my experience. It's always nice to have your gut feeling confirmed. In 1998 it seems oncologists seemed to ignore these facts.

[Emma]

Hi All
I also experienced problems with my hearing after chemotherapy, i am tone deaf, but then again my dad always did say that i was a little tone deaf when i sung anyway.......
I had cisplatin also

Thanks
Emma

[Kristin_B]

I am so glad I found this site!  For years when I would have my hearing test it would say that I just lost high pitch sounds- which is true but in a room full of people I get the funny noised in my ears and have a hard time hearing!  My parents would say I had selective hearing.